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Predicting Severe Postoperative Respiratory Complications following Abdominal Wall Reconstruction

Blatnik, Jeffrey A. M.D.; Krpata, David M. M.D.; Pesa, Nicholas L. M.D.; Will, Peter B.S.; Harth, Karem C. M.D., M.H.S.; Novitsky, Yuri W. M.D.; Rowbottom, James R. M.D.; Rosen, Michael J. M.D.

Plastic and Reconstructive Surgery: October 2012 - Volume 130 - Issue 4 - p 836–841
doi: 10.1097/PRS.0b013e318262f160
Reconstructive: Trunk: Original Articles
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Background: Patients undergoing abdominal wall reconstruction are at risk of developing major postoperative respiratory complications. The authors attempted to identify factors predictive of respiratory complications following abdominal wall reconstruction.

Methods: All patients who underwent complex abdominal wall reconstruction over a 2-year period were reviewed. The primary endpoint studied was severe respiratory complication, defined as respiratory insufficiency requiring intubation or transfer to a higher level of care.

Results: Sixty patients underwent complex abdominal wall reconstruction during the study period. The incidence of respiratory complications was 20 percent. Factors predictive of postoperative respiratory complication included age (p = 0.05), American Society of Anesthesiologists score (p = 0.04), and hernia defect size (p = 0.01). In addition, patients who developed respiratory complications were more likely to have had a greater change in plateau pressure (5.8 versus 2.3 cmH2O; p = 0.01). The greater the change in plateau pressure, the greater the risk of developing a respiratory complication: for a change in plateau pressure greater than or equal to 6 cmH2O, the odds ratio was 8.67; for a change in plateau pressure greater than or equal to 9 cmH2O, the odds ratio was 11.5.

Conclusions: Respiratory complications following abdominal wall reconstruction can be serious and are associated with prolonged hospitalizations. Patients with an increase in their plateau pressure of greater than 6 cmH2O are at an increased risk of severe postoperative respiratory complications.

CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, II.

Cleveland, Ohio

From the Departments of Surgery and Anesthesiology, University Hospitals Case Medical Center.

Received for publication April 27, 2012; accepted April 27, 2012.

Disclosure:Dr. Novitsky is a speaker for LifeCell Corporation and Davol and is a consultant for Davol and Kensey Nash. Dr. Rosen is a speaker for LifeCell. Research support was received from LifeCell, Davol, W. L. Gore & Associates, and Cook.

Michael J. Rosen, M.D., Department of Surgery, University Hospitals Case Medical Center, 11100 Euclid Avenue, Mailstop 5047, Cleveland, Ohio 44106, michael.rosen@uhhospitals.org

©2012American Society of Plastic Surgeons